Joseph Nader

The Involvement of miRNA in Carotid-Related Stroke

Cardiovascular disease is the leading cause of morbidity and mortality in developed countries. Stroke is associated with a marked disability burden and has a major economic impact; this is especially true for carotid artery stroke. Major advances in primary and secondary prevention during the last few decades have helped to tackle this public health problem. However, better knowledge of the physiopathology of stroke and its underlying genetic mechanisms is needed to improve diagnosis and therapy. miRNAs are an important, recently identified class of post-transcriptional regulators of gene expression and are known to be involved in cerebrovascular disease. These endogenous, small, noncoding RNAs may have applications as noninvasive biomarkers and therapeutic tools in practice. Here, we review the involvement of several miRNAs in cell-based and whole-animal models of stroke, with a focus on human miRNA profiling studies of carotid artery stroke. Lastly, we describe the miRNAs’ potential role as a biomarker of stroke.

First surgical implantation of a sutureless valve in the pulmonary outflow tract

disease. Technologic advancements are often developed in the adult population first. The unfortunate reality is that the development of novel devices and technology for children is limited by the relatively small volume of pediatric cardiac patients. Creative applications of these advances in adult medicine may prove to be the best source for innovative treatment strategies for challenging pediatric cardiac problems in the future.

Unusual Gastrointestinal Bleeding After Sutureless Aortic Valve Replacement: A Word of Caution

We report the clinical case of a male patient who presented, after an aortic valve replacement with a rapid deployment bioprosthesis, a Heyde-like syndrome, secondary to a moderate aortic paravalvular leakage. All the digestive and hematologic investigations confirmed the diagnosis. A redo surgery to fill the paravalvular gap was accomplished and the postoperative course was uneventful, with a normalization of the biological parameters. To our knowledge, this is the first described case of such a complication with the new generation of sutureless bioprosthesis.

Associated bare stenting of distal aorta with a Djumbodis ® system versus conventional surgery in type A aortic dissection

BACKGROUND The effectiveness of additional stenting of the distal aorta as compared to conventional surgery alone in type A aortic dissection (TAD) has yet to be proven. METHODS We conducted this multicenter comparative study to evaluate the effects of antegrade bare stenting of the dissected aorta beyond the distal anastomosis with a Djumbodis(®) device system (DDS). Outcomes that were measured included early outcomes, overall mortality from aortic cause and late aortic events including re-interventions. A consecutive series of 134 patients operated on in two participating centers were distributed into study and control groups according to the treatment received: conventional surgery with DDS (DJ group, n=42) or without (control group, n=92). RESULTS Operative mortality was 21.4% and 17.6% in the DJ and control groups, respectively (P=0.9), and was within pre-specified alarm lines for both groups. In multivariate analysis, the only independent predictor of operative mortality was the presence of any complication (cardiac tamponade or malperfusion, P=0.05), which occurred more in the DJ group (OR =1.3; non-significant). Sixty patients were included into the matched survivors cohorts study (propensity scoring). The aortic event-free survival at 7 years for early survivors was 77%±10% and 48%±11% in the matched DJ group and control group, respectively (HR =0.66). Late mortality from an aortic cause was 10% and 20% in the matched DJ group and control group, respectively (RR =0.5). Actuarial freedom from aortic or vascular interventions was 71%±10% and 67%±9% in the matched DJ and control group, respectively. Operative mortality was not influenced by the use of DDS as compared to conventional surgery alone for TAD. CONCLUSIONS We observed a trend towards better organ perfusion in the DJ group postoperatively, and more aortic events and deaths of aortic cause in the control group during follow-up.

A STEP FORWARD IN THE MINIMALIST STRATEGY FOR TRANSFEMORAL TRANSCATHETER AORTIC VALVE IMPLANTATION WITH THE EDWARDS SAPIEN-XT PROSTHESIS: FEASIBILITY AND SAFETY OF EARLY DISCHARGE

There is currently no consensus on the duration of hospitalization required after TAVI. We report the feasibility and safety of early discharge after transfemoral transcatheter aortic valve implantation (TAVI) with the Edwards SAPIEN-XT prosthesis. Between 2009 and 2013, 337 patients underwent

MAJOR VASCULAR COMPLICATIONS AFTER TRANSFEMORAL TAVI: INCIDENCE AND IMPACT ON 30-DAY MORTALITY ACCORDING TO VARC-1 AND VARC-2 DEFINITIONS

Major vascular complications (VC) remain an important issue after transfemoral transcatheter aortic valve implantation (TF-TAVI). Previous studies demonstrated that major VC were frequent with first-generation of transcatheter heart valves (THV) and were associated with higher 30-day mortality using

Killer coronary artery and aortic valve stenosis: A tricky case.

Anomalous origin of the left main coronary artery from the right coronary sinus is rarely diagnosed in elderly patients. We report such an anomaly in a 75-year-old lady presenting with chest pain and syncope. Preoperative screening revealed that her aortic valve was moderately stenotic. The patient underwent a successful unroofing procedure combined with aortic valve replacement. The outcome was uncomplicated and the patient remained asymptomatic at one year postoperatively.